Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration

项目摘要/摘要 冠状病毒病-2019年(新冠肺炎)是由冠状病毒引起的一种国际突发公共卫生事件 冠状病毒2(SARS CoV-2)病毒的呼吸道飞沫传播。美国有 成为大流行的震中，具有独特的区域模式。截至目前，COVID- 19死亡率在很大程度上是通过死亡证明进行监测的，这些死亡证明中提到了COVID- 19.然而，先前对超额死亡的分析显示，12%至25%的超额死亡 2020年没有直接分配到新冠肺炎。未分配给COVID的死亡百分比- 19也众所周知，各州和县级社会人口因素的差异很大。 然而，超额死亡率和超额死亡率在多大程度上没有被分配仍然是未知的。 对新冠肺炎的贡献因地区和城乡的不同而不同。拟议的补编 将在目前关于地理死亡率不平等的工作的基础上，通过将 重点关注新冠肺炎。我们关于新冠肺炎相关死亡率过高的初步工作有 显示新冠肺炎的死亡率和未分配给新冠肺炎的超额死亡率各不相同 基本上跨越了由其社会人口和健康状况定义的美国县的子集 并沿着城乡连续体的方向发展。这项前期工作也提出了 关于各州和县的死因编码质量的问题。这个 拟议的补充将使我们能够将我们的分析扩展到超额死亡率和直接 按地理和种族/民族分配的新冠肺炎死亡率。有相当多的证据 超额死亡率和新冠肺炎死亡率因种族/民族而异，但鲜有人知道 大流行对美国不同种族/民族亚群的影响因地理位置而异。我们会 还调查了死因编码差异对估计的潜在影响 超额死亡率和死亡率的地理不平等直接分配给新冠肺炎。令人担忧的问题 关于死因编码的质量也被国家统计局的新报告提出 科学院、工程和医学研究院，死亡率很高，而且还在上升 适龄工作的成年人。

PROJECT SUMMARY/ABSTRACT Coronavirus disease-2019 (COVID-19) is an international public health emergency caused by the respiratory droplet transmission of the coronavirus-2 (SARS CoV-2) virus. The United States has emerged as an epicenter of the pandemic, with distinctive regional patterning. To date, COVID- 19 mortality has largely been monitored using death certificates that contain reference to COVID- 19. However, prior analyses of excess mortality reveal that between 12% to 25% of excess deaths in 2020 were not directly assigned to COVID-19. The percent of deaths not assigned to COVID- 19 is also known to vary significantly by state and by county-level sociodemographic factors. However, it remains unknown to what extent excess mortality and excess mortality not assigned to COVID-19 differs by region and across the urban-rural continuum. The proposed Supplement will build upon and expand on current work on geographic inequalities in mortality by integrating a focus on COVID-19. Our preliminary work on excess mortality associated with COVID-19 has shown that mortality from COVID-19 and excess mortality not assigned to COVID-19 varies substantially across subsets of U.S. counties defined by their sociodemographic and health characteristics and along the urban-rural continuum. This preliminary work has also raised questions about the quality of the coding of causes of death across states and counties. The proposed supplement will enable us to expand our analyses to excess mortality and directly assigned COVID-19 mortality by geography and race/ethnicity. There is considerable evidence that excess mortality and COVID-19 mortality varies by race/ethnicity but little is known how the impact of the pandemic on the various U.S. racial/ethnic subgroups varies by geography. We will also investigate the potential impact of cause of death coding differentials on estimates of geographic inequalities in excess mortality and mortality directly assigned to COVID-19. Concerns about the quality of cause-of-death coding were also raised by the new report of the National Academy of Sciences, Engineering and Medicine, High and Rising Mortality Rates among Working-age Adults.